Alzheimer's disease Brain Featured Mental health The Memory Doctor

Is my mother safe in a nursing home?

Woman in nursing home

Question: With the recent news about an ex-nurse admitting to killing eight seniors in long-term care facilities, do I need to be worried about the safety of my mother in the nursing home?

Answer: Yes – you should be concerned about your loved one’s safety, but not because of harm by staff! The case of Elizabeth Wettlaufer, a former nurse who admitted to killing eight seniors in long-term care facilities in the London and Woodstock areas, is a rare event indeed. While reports of staff-on-resident abuse do occur, the majority of resident injuries from violence in long-term care are the result of resident-on-resident violence.

Most staff in long-term care are dedicated, hard working and compassionate individuals who tend to be under-paid and over-worked, given low staff-to-resident ratios. In fact, it is more likely that staff will be harmed by resident aggression than vice versa. This is because aggression and agitation are common in some patients with dementia, and residents are frequently institutionalized because their behaviour was hard for family caregivers to manage when they were living in their own homes. A recent report from the Ontario Coroner who investigates cases of death from violence, suggests that more than half of long-term care residents have a diagnosis of dementia and almost 50 per cent exhibit aggressive behaviours.

Following Wettlaufer’s admission of guilt, there were a number of calls for public inquiries into how such a thing could have occurred – but such an inquiry is really not necessary. It is well known what needs to be done to better protect vulnerable seniors in long-term care facilities from violence. First and foremost, we need better staff-to-resident ratios, better staff training, and a more enriched long-term care environment (including physical facilities like single rooms). These will lead to reduced staff-on-resident violence as well as resident-on-resident violence. Secondly, we need more and better oversight of facilities through scheduled inspections and responses to specific complaints.

Finally, as a family member, you also have a role to play. Visit or call frequently. This tells staff you are interested and concerned, and want to know what is going on at all times. It also allows you to see how care is provided, and inform staff about particular likes and dislikes that may make care easier and more comfortable. Get to know staff, the administration and the other residents. Knowledge of other residents and how they interact with your relative may help prevent difficult interactions. Get involved with Family Councils and help work towards improving the facility and the care provided.

Finally, if ever you see or suspect abuse by another resident or a staff person, whether it is your relative or anyone else, report it immediately to the staff, the administration or the Ministry of Health.

About the author

Dr. Nathan Herrmann

Dr. Nathan Herrmann is an affiliate researcher/scientist with Sunnybrook. For 25 years Dr. Hermann has been a memory disorders specialist. He has done research in the fields of mental health in the aging, including dementia, Alzheimer’s disease, depression, and suicide. Read his blog series: The Memory Doctor.